Posted on May 29, 2018, 2 p.m.
Patients with difficult to control asthma have been shown to have improved asthma symptoms using the anti-inflammatory eczema drug dupilumab, as published in The New England Journal of Medicine.
Two new studies have shown that dupilumab, which is an injectable anti-inflammatory drug approved by the FDA in 2017 for eczema, alleviates asthma symptoms and improved patient breathing ability better than that of standard therapies. Upwards of 2,000 patients with moderate to severe asthma were enrolled in the studies who all used standard asthma inhalers and some took oral steroids to control severe asthma symptoms.
One study showed that the rate of asthma exacerbations were almost cut in half while taking dupilumab compared to the placebo group. Dupilumab significantly reduced symptoms for all patients, but worked particularly well in patients with high numbers of a specific type of white blood cell eosinophils circulating in the bloodstream for whom exacerbations were cut by ⅔.
1,900 patients were included in the first study with moderate to severe asthma requiring use of at least 3 different inhalers to control symptoms: corticosteroid to reduce inflammation; a long acting bronchodilator to relax airway muscles; and albuterol as a rescue inhaler to quickly open airways in severe asthma attacks. At random patients taking these medications were either given a placebo or dupilumab for one year. Participants taking dupilumab were also randomly assigned higher or lower doses. In addition to decreased symptoms participants taking dupilumab displayed improve lung function in forced expiratory volume testing regardless of dose by approximately 130-200 millimeters. No significant differences were noted between higher or lower doses of dupilumab. Rate of ER visits and hospitalizations were improved in the dupilumab group, 6.5% of the placebo group required emergency care and 3.5% of the dupilumab group required emergency care due to asthma.
The second study showed benefits of dupilumab with the ability to wean severe asthma patients off of chronic oral steroids which can cause debilitating long term side effects which include things such as cataracts, diabetes, stunted growth, and osteoporosis. 200 patients were included in the second study using the same inhaled medications plus additional oral steroids. Half of the participants received dupilumab and were able to completely eliminate use of prednisone, 80% of the dupilumab group were able to cut doses in half.
Participants did report some side effects while taking dupilumab such as pain and swelling at the injection site with a short term bump, and increased numbers of eosinophil cells in the blood which is was also short term. 5 participants died during the study, but investigation revealed they had multiple severe medical conditions and none of the deaths were deemed related to the study protocol.
Materials provided by Washington University School of Medicine.
Note: Content may be edited for style and length.
Klaus F. Rabe, Parameswaran Nair, Guy Brusselle, Jorge F. Maspero, Mario Castro, Lawrence Sher, Hongjie Zhu, Jennifer D. Hamilton, Brian N. Swanson, Asif Khan, Jingdong Chao, Heribert Staudinger, Gianluca Pirozzi, Christian Antoni, Nikhil Amin, Marcella Ruddy, Bolanle Akinlade, Neil M.H. Graham, Neil Stahl, George D. Yancopoulos, Ariel Teper. Efficacy and Safety of Dupilumab in Glucocorticoid-Dependent Severe Asthma. New England Journal of Medicine, 2018; DOI: 10.1056/NEJMoa1804093